Comparative analysis of arthroscopic debridement in osseous versus soft tissue anterior ankle impingement

Abstract

Methods: Our study included 14 patients diagnosed as cases of anterior ankle impingement on the basis of clinical and radiological examination. They were segregated into two groups (on the basis of cause of impingement (osseous versus soft tissue)). Both groups were treated by arthroscopic debridement. Primary outcome was patient satisfaction, which was assessed by Likert scale and clinical outcomes were measured using AOFAS ankle-hind foot scale, VAS score, range of motion and time to return to pre-injury activity level in both groups.Results: Mean follow-up was of 15 months where eleven patients reported an excellent recovery, two patients had good recovery while one patient reported poor outcome. Mean AOFAS ankle hind foot scale improved from 50.5 preoperatively to 85.71 postoperatively (statistically significant; p value -0.0001). Mean Likert scale value post-operative was 4.21.VAS score showed significant improvement in patients of both the groups. Range of motion was slightly better in soft tissue impingement type with a relatively shorter time to return to sports or preinjury activity level as compared to osseous impingement group. Conclusions:The patients in both the groups had comparable outcomes with no statistically significant difference with regard to patient satisfaction and clinical outcome.

Arthroscopic management of post traumatic anterolateral soft tissue ankle impingement

“…In advanced cases, mechanical impingement may mold the tissue into a hyalinized meniscoid lesion, which was originally described by Wolin et al [11,12] . Other impinging factor is hypertrophy of an accessory fascicle of the anterior inferior tibiofibular ligament (AITFL) [7,8,13] . This accessory fascicle is a common variant that was first described by Bassett et al [14] .…”

“…It can hypertrophy after repeated trauma, causing impingement, especially when other anterolateral supporting structures are compromised [10,13] . The diagnosis of ALSTAI is based mainly on history and physical examination [2][3][4][5][6][7][8][9][10][11]13] It should be suspected in any case of chronic complaints after an ankle sprain [3,4] . It can be highly suggested on clinical basis [5][6][7][8] .…”

“…It can be highly suggested on clinical basis [5][6][7][8] . The principal role of plain radiographs, CT and MRI should is in differential diagnosis and detection of other causes of anerolateral ankle pain as bony impingement, osteochondral lesions and ankle instability [13,[15][16][17] .…”

“…Ankle arthroscopy is the gold standard for diagnosis and assessment of ALSTAI [3,4,13,[15][16][17][18] . Successful treatment of this disability depends on proper identification of the exact leading pathology [7][8][9][10] .…”

Prevalence and location of bone spurs in anterior ankle impingement: A cadaveric investigation

“…Pain is generally secondary to bony exostoses off the tibia or talus impinging on interposed hypertrophied synovium or scar tissue within the anterior ankle during squatting, sprinting, stair climbing and landing (Berberian, 2001;Biedert, 1991;Branca, 1997;Rasmussen and Hjorth Jensen, 2002;Sanders and Rathur, 2008;Talusan, 2014). AAI is generally observed in young, athletic populations participating in activities requiring repetitive hyperdorsiflexion or direct impact on the ankle with a history of recurrent ankle inversion injuries (Devgan, 2016;St Pierre et al, 1983), being common in ballet dancers and soccer players (Massada, 1991;O'Kane and Kadel, 2008;Stoller, 1984;Tol et al, 2001Tol et al, , 2002. In patients with persistent symptoms despite conservative management, surgical excision of bony spurs and debridement of impinging soft tissue in the anterior ankle is recommended (Talusan, 2014).…”